2 - Asthma Flashcards
What are normal breath sounds called?
vesicular
Describe bronchial breath sounds
- tubular or hollow
- characteristic pause between inspiration/ expiration - occurs in bronchial tree
What types of crackles are there?
- Coarse - through lung secretions
- Fine - reopening of alveoli
What is a Ronchial breath sounds?
a low pitched wheeze
What is a Wheeze and what causes it?
- can be monophonic or polyphonic (COPD)
- caused by narrowing of the airways
What is stridor?
- partial obstruction in the airway, usually upper
- MEDICAL EMERGENCY IN CHILDREN
O SHIT ME
O xygen (94-98%)
S albutamol (5mg
H hydrocortisone (100mg IV) / prenisalone (40mg oral)
I patropium (0.5mg) (FEV < 75%)
T heophyline
M agnesium (1.2-2g IV)
E scalate
What lines of treatment are for asthma?
1 - SABA
2 - steroid (beclemetasone)
3 - LABA
4 - increase inhaled steroids
5 - 4th drug
What is good for aspirin induced asthma?
Montelukast - leukotriene receptor antagonist
What does a FEV/FVC ration indicate?
>70% = restrictive
<70% = obstructive
COPD vs Asthma
Asthma FEV can improve by 20% where as COPD is less likely
What are the features of type1 respiratory failure?
- pO2 < 8
- PCO2 < 6.7 or normal
- ventilation perfusion mismatch: air O2 is less than blood O2 demands
What are the feature of type 2 respiratory failure ?
- pO2 < 8
- PCO2 > 6.7 - decreased
- pH - inadequate ventilation and percussion building up
What does SBAR stand for?
S ituation
B ackground
A ssessment
R ecommendation
DR ABCDE of CXR interpretation
D etails
R IPE
A airway
B reathing
C ardiac
D iaphragm
E xtra
D of CXR interpretation
Details
Name
DoB
AP or PA
supine or erect
What does RIPE stand for in CXR interpretation?
Rotation - clavicle equdistance to the spine of the vertebrae Inspiration - 6-7 posterior ribs
Picture - clavicle, scapula and under the diapragm
Exposer - can the vertebrae be seen behind the mediastinum
A of CXR interpretation
- trachea deviation?
- level of the carina
B of CXR interpretation
consolidation
vesicular marking to the edge of lung
pleura - mesothelioma
C of CXR interpretation
heart borders
cardiothoracic ratio (PA)
aortic knuckle
D of CXR interpretation
air under diaphragm
costophrenic angle
cardiacphrenic angle
domes 1.5cm in height
E of CXR interpretation
bone fracture
pacemakers
soft tissue
Sarcoidosis
-bilateral hilar markings
Loss of silhouette sign
- loss of costophrenic angle
- indicates pneumonia etc
What is the ABCDE assesment?
Airway
Breathing
Circulation
Disability
Exposure and Everything Else
How to asses Airway?
Responsive
Talking
Breath sounds: stridor, gurgling, snoring
What intervention may need to be done Airway?
Open airway - tilt chin lift
Suction
Nebulisers - salbutamol
Nasopharingeal/ oropharyngeal/ igel
How would you assess breathing?
RR
Sats
Breath sounds
Percussions
What intervestigations would you do during breathing?
Sit up
O2
ABG
CXR
What does Bat wings on CXR indicate
pulmonary oedema
What does bibasal crepitations indicate?
pulmonary oedema
How do you treat pulmonary oedema?
flurosemide
nitrate
if severe: use CPAP
On examination of the lungs there is a global wheeze. What does this indicate?
Asthma
On examination lung breath sounds are quiet and global, polyphonic wheeze. What does this indicate?
COPD
On examination lungs sound quiet at bases and dull to precuss. CXR shows loss of costophrenic and cardiophrenic angles. What des this indicate?
Plural effusion
How is a plueral effusion treated?
Treat cause
if not consider chest drain
On examination precussion is hyper-resonant with decreased breath sounds with possible mediastinal shift. What does this indicate?
Tension pneumothorax
(also tracheal deviation but didn’t want to make it too easy)
On examinaiton lungs have localised crackles with bronchial breath sounds. What does this indicate?
Pneumonia
(also raised temp, increased RR etc.)
What questions to ask an asthmatic at thier annual review?
Have you had difficulty sleeping due to asthma?
Has your asthma interfeared with daily activities?
Have you had your asthma symptoms during the day?
How to asses circulation?
HR
BP
Cap refill
Temp
Urine output
What interventions may need to be done in circulation?
“Two wide bore canulas”
take bloods
Give fluid
Catherterise
Do ECG
“1 in, 1 out, 1 in ….”
How to assess disability?
Dont ever forget glucose - BMs
AVPU or GCS
PEARL
What interventions may need to be done in disablity?
IV dextrose
IM glucagon
How is exposer/ everything else assessed?
Examination
